For men with age-related decline in testosterone levels, there is significant controversy over the risks and benefits of testosterone supplementation. Despite a paucity of data, testosterone sales have increased markedly in the past decade. The Testosterone’s Effects on Atherosclerosis Progression in Aging Men (TEAAM) Trial evaluated the impact of increasing testosterone concentrations on progression of […]
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Coronary Computed Tomography Angiography Versus Radionuclide Myocardial Perfusion Imaging in Clinical Evaluation of Chest Pain Admissions
Chest pain concerning for a coronary syndrome leads to millions of hospital admissions each year that is often evaluated with diagnostic testing. As a noninvasive diagnostic study, coronary computed tomography angiography (CCTA) has been shown to have excellent diagnostic capabilities. However, concerns over CCTA remain, including radiation exposure, false-positives, and trials of the diagnostic modality […]
Informed Decision Making for Percutaneous Coronary Intervention for Stable Coronary Disease
Prior studies suggest patients are often misinformed about the anticipated benefits of PCI for stable coronary disease. However, there is little data on patient-provider discussions that may explain discrepancies in patient understanding about the limited benefits of PCI in this setting. Rothberg and colleagues performed a cross-sectional analysis of 59 conversations between providers and patients […]
Lipid lowering drugs and risk of vascular events in older patients
Although elderly patients are at higher risk of cardiovascular events, the majority cardiovascular trials exclude these patients. Accordingly, little is known about the use of lipid lowering medications for prevention of cardiovascular events in elderly populations. This prospective cohort study evaluated the association between use of statins or fibrates for prevention of vascular events among […]
Improved Atrial Fibrillation Outcomes Despite Rising Arrhythmia Prevalence
Little is known about temporal trends in atrial fibrillation (AF) incidence, prevalence, and outcomes. Using the Framingham Heart Study, Schnabel and colleagues assessed AF incidence, prevalence, and outcomes over 50 years (202,417 person-years). Researchers drew on a cohort of 9,511 participants enrolled between 1958 and 2007 in which 1,544 incident AF cases (47% women) were […]
Investigating chest pain: anatomy or function?
Among patients with chest pain, it is unclear if anatomic assessment of coronary obstruction or functional assessment with stress testing leads to better patient outcomes. In this randomized controlled trial of 10,003 symptomatic patients, individuals were randomly assigned in a 1:1 fashion to either anatomical testing with coronary CT angiography (CTA) or to functional testing […]
Antiplatelet therapy in long-term risk reduction after myocardial infarction
The activated platelet is central to development of ischemic cardiovascular events. Guidelines recommend treatment with a P2Y12 receptor antagonist for 1-year after myocardial infarction (MI) to reduce the risk of recurrent events. The PEGASUS trial sought to determine the impact of using the P2Y12 antagonist ticagrelor as part of long-term therapy after MI. In this […]
Precision Medicine to Reduce Bleeding with PCI
Periprocedural bleeding remains one of the most common adverse events after percutaneous coronary intervention (PCI) and is associated with increased mortality. Although strategies to minimize PCI bleeding have been identified, these strategies are infrequently applied to patients at highest bleeding risk. Using a pre-post study design, Spertus et al. evaluated the impact of assessing individual patient bleeding risk from validated models and providing this bleeding risk estimate in personalized informed […]
Relationship Between Physical Activity and Mortality
The 2008 Physical Activity Guidelines for Americans recommended 150 to 300 minutes of moderate-intensity or 75 to 150 minutes of vigorous-intensity aerobic activity weekly for optimal health. However, these guidelines acknowledged uncertainty on the upper threshold of benefit or potential harms of high activity levels. Using data from 6 pooled cohorts from the National Cancer Institute Cohort Consortium (baseline 1992-2003) […]
Long-Term Outcomes of Transcatheter Aortic Valve Replacement
The Placement of Aortic Transcatheter Valves (PARTNER) trial demonstrated that transcatheter aortic valve replacement (TAVR) for high-risk patients with aortic stenosis resulted in similar outcomes at 1, 2 and 3 years compared with surgical aortic valve replacement (SAVR). The present study reports the 5-year outcomes of this trial. The study enrolled 699 patients who were […]